A succession of high-priced specialty drugs flooded the Rx marketplace in 2014, dominating the headlines. Introduced by pharmaceutical giants such as Gilead and AbbVie, the new crop of revolutionary specialty drugs are able to cure rather than treat certain complex diseases and health conditions, such as Hepatitis C. Many new drugs in development are specialty drugs, which are different from traditional oral solids or powders formed into a pill form, relying rather on infused or injected medications created out of living cultures and complex sets of amino acids or proteins.

Hepatitis C drugs Sovaldi and Harvoni (both Gilead) and Viekira Pak (AbbVie) run $84,000 to $100,000 per treatment and, depending on the patient’s genetic makeup, can provide a cure rate of 90%-plus, for example. A number of physician practices are waiting so they can treat patients with these new specialty drugs that provide better outcomes than previous products. What’s more, employers should expect specialty drug utilization, like the Hep C drugs, to increase their pharmacy costs as more patients are diagnosed and treated.

Holding PBMs Accountable

Employers should make sure PBMs are performing prior authorizations on Hep C and other specialty drugs because the drug’s efficacy depends very much on the patient’s genotype. If the genotypes are not being tested the drugs could be a wasted spend. Additionally, large PBMs are excluding one manufacturer’s product in exchange for coverage on another, so employers will need to hold PBMs accountable to lower prices and better management, according to Pharmacy Analytics Consultant Brandon Crosby from Lockton’s National Pharmacy Practice.

Generic Drug Inflation

Some pharmaceutical manufacturers are choosing to exit the production of certain generic drugs due to low profitability, and some chains are removing certain generics from their low-cost drug lists: Walmart removed doxycycline hyclate and tetracycline, for example. Generic and brand manufacturers are benefiting from the economic inflation that ensues when product supplier numbers drop. What’s more, some PBMs/contracts exclude certain generics—such as generics in short-supply—from generic discount guarantees, and these contract exclusions can hurt plan sponsors more than ever, says Crosby.

Proactive Pharmacy RFP Procurement

Employers should initiate an RFP procurement for the Pharmacy Benefit as soon as possible and continue to hold their PBMs accountable in this unstable market. This will ensure that PBMs are offering a set of services tailored to the employer’s strategic benefit plan, which will become increasingly important in the future. Proactive RFPs ensure employers are getting the best price available: They establish auditable discount guarantees; auditable rebate guarantees; auditable dispensing fee guarantees; auditable administration fee guarantees; and contractual language that supports the guarantees. The best pharmacy RFPs also measure financial impact, member disruption, and pharmacy network disruption, says Crosby.

“Without these terms you’re flying blind and PBMs can deliver whatever pricing they like—and this analysis can be performed in the middle of a two- or three-year PBM agreement,” he adds.

Metrics to Manage the Rx Benefit

Crosby concludes: “Measuring the PBM’s pricing performance and audit reconciliation results on an annual basis is critical to ensure that the value of the deal is actually delivered. There are many ways for a PBM to under-deliver on pricing. Lockton performed 44 annual audits in 2014, and 39 of them produced refund checks back to the plan sponsor. The total underperformance paid out to our clients in 2014 was $2,800,000. Quarterly pricing checks maintain a focus on the PBM, who tend to perform better when they know they’re being watched. This is a newer idea in PBM, but can make a big difference for plan sponsor budgets and helps ensure that HDHP plans are fair to the members and the plan. We’ve been amazed at the amount of pharmacy spend left on the table due to less-than-best-in-class PBM discounts, fees, rebates, contract terms and inability to enforce unmet performance guarantees.”

Free Rx Check-Up

Looking for strategic, vendor-agnostic support for your pharmacy benefit management function? We can help: Lockton Companies now has a free Rx Benefit Check-Up for self-funded employers. Contact me today at RRuotolo@Lockton.com or (646) 572-3962 to set an appointment with our National Pharmacy Analytics Practice and actuaries who support our core benefit teams in this area.

Accordingly, the Kaiser Family Foundation and the Health Research & Educational Trust has conducted an annual survey of private and nonfederal public employers during the past 16 years to provide current information about employer-sponsored health benefits and actionable guidance for HR leaders and practitioners like you.

To help with your 2015 planning, I’ve made the Kaiser employer-sponsored health benefits summary findings for 2014 available as a free download below.

2015 Employer-Sponsored Health Benefits Planning

Interestingly, the 2014 survey reports considerable stability among employer-sponsored plans, with a similar percentages of employers offering benefits to at least some employees and a similar percentage of workers at those firms receiving benefits coverage as compared to last year. Family premiums appeared to increase at a modest rate and single premiums also appeared to be statistically consistent with those reported last year. What’s more, on average, workers with coverage contributed the same percentage of the premium for single and family coverage as last year.

But the relative quiet of 2014 could be the calm before the 2015 storm as the employer shared-responsibility provision in the ACA takes effect for large employers—the provision requiring firms with more than 100 full time equivalent employees (FTEs) in 2015 and more than 50 FTEs in 2016 to provide coverage to their full-time workers or possibly face a penalty if workers seek subsidized coverage in health care exchanges, the report concludes.

Registration Note:Please register only once for each group of employees who will view and listen to the presentation through a single computer. You are welcome to register multiple groups, but we need to know how many log-in ports to reserve for each session.

CEUs: We now offer Continuing Education Units (CEUs) from the Human Resources Certification Institute (HRCI) for many of the webinars presented by the experts in Lockton Benefit Group. Attendees of the webinars can obtain CEUs for Professional in Human Resources (PHR), Senior Professional in Human Resources (SPHR), and Global Professional in Human Resources (GPHR) certification. To receive CEUs, you will need to log into the presentation individually so that we have a record of your attendance.

For Additional Assistance

Thanks for reading and feel free to contact me at RRuotolo@Lockton.com or 646.572.3962. To stay informed and receive future blog updates by email simply enter yours into the opt-in email box at the top of the page.

]]>http://robruotolo.com/kaiser-benefits-survey-offers-key-insights-for-2015/feed/0Health Care Reform Hot Buttons for 2015http://robruotolo.com/health-care-reform-hot-buttons-for-2015/
http://robruotolo.com/health-care-reform-hot-buttons-for-2015/#commentsThu, 11 Dec 2014 22:10:01 +0000http://robruotolo.com/?p=1433]]>Implementation of the employer mandate is just around the corner, along with many other health reform changes in 2015! Be sure to mark your calendars for Thursday, Jan. 22, 2015, where Lockton will provide a complimentary webcast on what to expect from health reform in 2015.

Hot button topics to be discussed include:

Incentivizing Employees to Drop Coverage: The feds have issued clear warnings to employers who attempt to induce sick employees to leave their employer plan and find insurance on the public exchanges. The feds have put checks and balances in place, and these will be discussed in the context of 2015 health reform.

Reference-Based Pricing (RBP): Many large employers are relying more on reference-based pricing, where the plan pays a specific amount for a particular procedure, incorporating it into their plan design as way to minimize cost increases and improve health outcomes for their employees. But recent agency guidance has made implementation of RBP increasingly difficult, says Lockton Senior Vice President and Director of Compliance Services Mark Holloway. “Guidance from the feds makes it difficult to implement RBP because of the many requirements. If a plan does not meet the new rules, then amounts paid by the employee over the reference price must be applied to the plan’s out-of-pocket limit,” says Holloway.

Minimum Value Lite Plans: The IRS has offered guidance on the new generation of pared-down minimum value plans. Employers looking to satisfy the federal requirement for minimum (value) essential coverage must have plans with an actuarial value of at least 60 percent. The ramifications will be discussed, including options for employers who planned on offering plans with no hospitalization coverage next year.

Wellness Rules and the EEOC: A spate of recent lawsuits against employers by the Equal Employment Opportunity Commission (EEOC) has put several common features of wellness program design at risk, including biometric screenings, health risk questionnaires and spousal participation. These cases will be discussed, including the Honeywell litigation, which involves an ACA and HIPAA compliant wellness program.

New Cafeteria Plan Qualifying Event allows employees to drop coverage mid-year, enroll in plan on the state or federal exchange: “This is good news for employers—if an employee has premature triplets they can now go to the exchange,” says Holloway.

The New Congress: Implications for health reform and wellness programs. Holloway concludes: “The ACA is not going to be repealed—but Congress will do some fiddling. For example, the definition of full-time employee may move up from 30 hours—perhaps not to 40 hours, but it could land somewhere in between 30 and 40.”

Other topics to be discussed include:

Temporary Staffing Labor: A look at play or pay from both sides.

Employer Reporting: Making sense of the havoc, possibility of a delay?

Opting Out of the Contraceptive Coverage Mandate: Who’s affected, who isn’t?

Expiration of Play-or-Pay Transition Rules after 2015—transition rules that delay the effective date of play-or-pay for non-calendar plans.

Feds Hopes That States Will Reign in Small Self-insured Plans: Will they?

Registration Note: Please register only once for each group of employees who will view and listen to the presentation through a single computer. You are welcome to register multiple groups, but we need to know how many log-in ports to reserve for each session.

CEUs: We now offer Continuing Education Units (CEUs) from the Human Resources Certification Institute (HRCI) for many of the webinars presented by the experts in Lockton Benefit Group. Attendees of the webinars can obtain CEUs for Professional in Human Resources (PHR), Senior Professional in Human Resources (SPHR), and Global Professional in Human Resources (GPHR) certification. To receive CEUs, you will need to log into the presentation individually so that we have a record of your attendance.

Recordings: The webcast will be recorded and available online.

Thanks for reading and feel free to contact me at RRuotolo@Lockton.com or 646.572.3962 and enter your email in the opt-in email box at the top of the page to receive future blog updates via email.

]]>http://robruotolo.com/health-care-reform-hot-buttons-for-2015/feed/0Routine Wellness Program Design Features Under Attack by EEOChttp://robruotolo.com/routine-wellness-program-design-features-under-attack-by-eeoc/
http://robruotolo.com/routine-wellness-program-design-features-under-attack-by-eeoc/#commentsMon, 03 Nov 2014 15:08:57 +0000http://robruotolo.com/?p=1423]]>A spate of recent lawsuits against employers by the Equal Employment Opportunity Commission (EEOC) has put several common features of wellness program design at risk, including medical screenings, biometric testing, health risk questionnaires and mandatory spousal participation.

The EEOC sued two Wisconsin employers during the last four months for conditioning health plan enrollment on employees’ submission to biometric screening or shifting the entire cost of coverage to employees who declined to participate. These programs seem permissible under the Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA), but the EEOC, who is charged with enforcing the Americans with Disabilities Act (ADA), has alleged they violate the ADA’s prohibition on involuntary medical screenings.

While these cases raised the eyebrows of wellness program sponsors, relatively few have this aggressive design for employees who fail to complete a health risk assessment. But a recent challenge in federal court against Honeywell International by the EEOC seemed to broaden the offensive to include routine wellness program arrangements.

Honeywell’s Wellness Program

Honeywell’s program, and the EEOC’s claims against it, hit closer to home. The Honeywell program appears to be compliant with ACA and HIPAA wellness program rules. But after receiving complaints from some employees, the EEOC asked a federal trial court in Minnesota to prevent Honeywell from implementing important aspects of its wellness program for 2015.

Published reports indicate that the Honeywell program includes the following relatively common wellness program features:

Health savings account (HSA) contributions are conditioned upon the employee and an employee’s covered spouse completing a health risk questionnaire and biometric screening.

Employees/spouses who do not complete the biometric screenings are assessed a health insurance premium surcharge.

Employees/spouses who are tobacco users, and those who refuse to submit to testing for tobacco use, are assessed an additional health insurance premium surcharge.

“What’s more, the EEOC seems to be challenging the mere fact of requiring spouses to participate in a wellness program to get an employee discount in the Honeywell case,” says Lockton ERISA Compliance Attorney Scott A. Behrens. “An EEOC win could strip employers’ ability to require spousal participation, which is a critical piece of the puzzle. Spouses often have more healthcare costs than employees, and if a wellness program is prohibited from addressing key factors that drive healthcare costs it loses much of its effectiveness and reason to exist,” Behrens adds.

The ADA’s Application to Wellness Programs

The ADA limits the circumstances in which an employer is permitted to require a medical examination or require employees to answer health-related questions. Typical health risk questionnaires and biometric screenings will be considered medical inquiries within the purview of the ADA. Exceptions under the ADA apply to examinations or questions that are voluntary, but they won’t be considered “voluntary” if there’s a penalty for not participating.

So what comprises a penalty? The EEOC has been infuriatingly silent on this question for years. The EEOC’s Wisconsin employer suits seem to indicate that shifting all the cost of coverage to employees, or denying coverage outright, goes too far and amounts to a penalty. While the Honeywell suit reflects an effort by the EEOC to broaden the definition of penalty to encompass rather common wellness program incentives.

There’s another ADA exception that’s relevant here. Medical inquiries, like biometric screenings, are permissible under the ADA if they’re part of a “bona fide benefit plan.” In a 2012 ruling, a federal appeals court concluded that a wellness program sponsored by Broward County, Florida was not subject to challenge under the ADA, because it was part of the County’s health plan; that is, it was part of a bona fide benefit plan. Broward Country assessed a $20-per-pay-period premium surcharge against employees who refused to submit to biometric screenings.

It‘s unclear how the federal trial court will rule in the Honeywell case, but Behrens says a couple of things are clear: First, the results in the Broward County case are not binding in the Honeywell or Wisconsin cases, but the courts in the latter cases will certainly read and consider the Broward County decision. Certainly, that decision signals federal courts’ willingness to be more flexible than the EEOC.

“What’s more, we know courts are loathe to assume that Congress intended to make laws that conflict with each other. Where laws appear to conflict, as the ADA and ACA/HIPAA appear to do with respect to wellness programs, courts will search for a way to reconcile them. It seems plausible to us that the courts will allow the ACA/HIPAA rules to trump the EEOC’s more restrictive interpretation under the ADA,” he adds.

Evaluating Your Response

But that remains to be seen. In the meantime, wellness program sponsors who want to take extra steps to insulate their programs from EEOC scrutiny might consider whether their wellness programs are treated as part of their health plan. Facts that the appeals court in the Broward County case found important were that the wellness program was available only to health plan enrollees, the wellness program was communicated as part of the health plan in multiple disclosures to employees, and the same insurer provided both the health plan coverage and wellness program services.

Further, wellness program sponsors might want to consider plan design changes if they currently condition health plan participation upon the completion of a health-related questionnaire/biometric screening or require employees who fail to complete the questionnaire/biometric screening to pay all or a significant amount toward the cost of health plan coverage.

Behrens concludes: “The suits against Honeywell and both Wisconsin employers were filed by the EEOC’s Chicago regional office. The Chicago regional office oversees most of northern Illinois, Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin. Of course, other EEOC regional offices might begin pursuing similar claims, but employers in these six states may have extra incentive to review and update their wellness program design.”

“We may see the national EEOC office try to reign in the Chicago regional office, once they’ve provided guidance on what constitutes a penalty and fleshed out the voluntary program details,” he adds.

Obesity should be included under the American with Disabilities Act (ADA) and employers must treat it as a condition protected from discrimination under law, similar to other disabilities, a U.S. District Court recently ruled in Missouri.

The Equal Employment Opportunity Commission (EEOC), the governing agency for the ADA, has stated unequivocally that employers can’t discriminate against individuals with disabilities. This is established law, says Lockton Companies Assistant Vice President and HR Consultant Stacie Engelmann.

Employers should also be careful about making obesity assumptions, specifically during the hiring process, for example, where an applicant is applying for a job that requires physical labor, such as lifting more than 25 pounds. Engelmann advises that a physical screening should be part of the hiring process because—whether the individual looks fit or not—he or she may have an underlying health condition or some other physical or mental impairment that surfaces during the physical examination. Having a health care provider acknowledge the new hire is physically able to perform the job is also in the employer’s best interest, spreading accountability and limiting liability going forward, she said.

But there’s now a greater onus of obligation on employer’s to make accommodation. A forklift operator, for example, who has been able to do his job and then becomes obese, might pose the kind of situation where an employer needs to make accommodation. The forklift operator’s seat belt may no longer fit around his waist, for example, impairing his ability to do his job for safety reasons. To limit liability it would then be advisable for an employer to try to make accommodation with a seatbelt extender, if one was available, says Engelmann.

In light of the American Medical Association’s recent designation of obesity as a disease, we might expect a rise in obesity discrimination cases.

Evaluating Your Response

Employers may want to take a fresh look at evaluating their internal and ADA-defined interactive process, ensuring that there’s good two-way communication and dialogue between HR, managers and direct reports. HR should learn from the employee if there’s a piece of equipment that needs modification, or if a working hours schedule modification is in order, for example. Then HR might ask the employee for some back-up information—this is the type of back and forth that’s encouraged, adds Engelmann.

Employers need to review their HR policies to make sure employees and managers know where to go to request a workplace accommodation, if needed.

Our Lockton HR professionals are ready to help evaluate your internal practices and establish better procedures.Please reach out if we can be of further assistance atRRuotolo@Lockton.com.

]]>http://robruotolo.com/avoiding-workplace-liability-obesity/feed/0FMLA Audits On the Rise: Are You Ready?http://robruotolo.com/fmla-audits-on-the-rise-are-you-ready/
http://robruotolo.com/fmla-audits-on-the-rise-are-you-ready/#commentsFri, 19 Sep 2014 19:35:22 +0000http://robruotolo.com/?p=1371]]>Is your organization prepared to pass a Department of Labor (DOL) investigation into Family and Medical Leave (FMLA)compliance?

The DOL’s new FMLA Policy Enforcement Chief, Helen Applewhaite, has announced stepped-up enforcement of leave administration, declaring 2014 to be a decisive year for FMLA enforcement. The DOL will be conducting on-site audits of employers’ procedures—including manager and employee interviews—to determine FMLA compliance, with particular focus on systemic FMLA issues and workplace areas where leaves of absence tend to be more frequent.

In this first of two blog posts, we’ll explore what you can do to prepare for a DOL compliance audit, and next month we’ll discuss workplace disability leave administration, and its importance to the overall audit.

Preparing for the DOL’s FMLA Audit

The DOL published its Notice of Proposed Rulemaking to revise the definition of spouse under the FMLA in June. Last August, the DOL updated its public guidance to remove any reference to restrictions imposed by the Defense of Marriage Act (DOMA), expressly noting that the FMLA’s definition of spouse covers same-sex spouses, but only those residing in states recognizing such marriages. This latest revision uses the “place of celebration” standard to determine FMLA eligibility, permitting a qualified employee in a legally recognized same-sex marriage to take a job-protected leave of absence for his or her spouse or family member regardless of where he or she lives.

“Previously, administrators wrestled with conflicting guidance for same-sex married couples and may have had a hard time keeping things straight when it came to cafeteria plan elections, COBRA, ERISA and FMLA, so from that perspective the revision should be a welcome change for most employers,” says Lockton Companies Assistant Vice President and HR Consultant Stacie Engelmann.

“But this also means that a number of employees who historically have not been eligible for FMLA and generally could only use their sick or vacation time (as applicable), will now be eligible to take up to 12 weeks of leave protected by the FMLA to care for their same-sex spouse with a serious health condition,” Engelman adds, and advises: “Although health reform is top-of-mind right now, employers still need to remember the risks associated with improper FMLA administration, including fines associated with a failed audit.”

To prepare for a DOL on-site audit, Engelmann’s team recommends:

Reviewing your policy: Have you made the 2013 revisions (please refer back to February 2013 and July 2013 HR Bulletins). Are you watching for any updates you may have to make after this year’s revisions? Are you sharing your policy with employees?

Sharing with employees: Do you have the current FMLA poster in the required locations? Are you sharing your organization’s policy and required notices with employees? Do your employees know their rights and responsibilities under FMLA and how to request it when needed?

Training supervisors: Do your supervisors know what might constitute a request for leave so they can put you on notice? Do your supervisors understand the requirements and protections of FMLA leave so they’re not inadvertently violating the regulations?

Making sure to use up-to-date forms and legal correspondence with employees: Are you using the current versions of the DOL model notices or a compliant one you’ve created? Are you sharing GINA notice, if needed? Do you know what information you should or shouldn’t be requesting?

Reviewing your record-keeping: Ensure your records are in order. FMLA regulations require employers to maintain required records for a minimum of three years. Do you need to update/revise your record-keeping processes?

Lockton’s “Friendly” On- Site Audit

Not sure if your organization is ready for a DOL audit? Lockton’s FMLA compliance experts offer employers a “friendly” on-site audit—a test-run of sorts—where we investigate internal procedures and processes to determine how well your organization complies with the Family and Medical Leave Act. We coach our clients through the audit administrative process, with special attention to organizations with multiple locations, where the state FMLA policy may differ—may be more generous, for example—than the federal FMLA regulations.

Has your organization been the target of FMLA enforcement? Share your experience in the comments section below—we’d love to hear from you.

]]>http://robruotolo.com/fmla-audits-on-the-rise-are-you-ready/feed/2IRS Releases Draft ACA Employer Reporting Formshttp://robruotolo.com/irs-releases-draft-aca-employer-reporting-forms/
http://robruotolo.com/irs-releases-draft-aca-employer-reporting-forms/#commentsThu, 07 Aug 2014 16:17:00 +0000http://robruotolo.com/?p=1342]]>The IRS has released draft forms that insurers and sponsors of self-insured plans can use to demonstrate compliance with the ACA’s individual mandate during their annual federal tax filing. The forms may be used beginning in early 2016 to report on the individuals who had coverage during the 2015 calendar year.

The forms will also be used by employers with insured and self-insured plans who are subject to the ACA’s employer mandate to demonstrate compliance. This filing will also be made on the basis of the calendar year, regardless of the fiscal year on which the employer administers its health plan(s)—the first is due in early 2016 and will also be based on the 2015 calendar year.

Non-calendar year health plan sponsors that may defer compliance with the employer mandate until the first day of their plan’s 2015-16 fiscal year still need to file a report with the IRS for the entire 2015 calendar year. Our experts in the Lockton Health Reform Advisory Practice have posted a summary of the final regulations governing these reporting obligations, in the Spring 2014 Compliance News eBook, page 50 (click to download).

The forms are available here in a separate downloadable White Paper (click to download). The Lockton Health Advisory Practice noted that the draft forms do not contain instructions, but expects the IRS to make draft guidance available in September. They’re worth reviewing now because they indicate key data points that are important to the IRS, they said.

IRS Raises Affordability Threshold for 2015
In other news, the IRS will raise the affordability threshold for 2015. Employers subject to the ACA’s employer mandate understand that they must satisfy Tier 1 and Tier 2 obligations to avoid penalties. An employer satisfies Tier 1 by offering minimum essential coverage to an adequate percentage (70 percent for 2015, 95 percent for later years) of its full-time employees and their biological and adopted children to age 26 (perhaps through the month the child attains age 26).

An employer satisfies Tier 2 by ensuring the offer of employee-only coverage satisfies a minimum value requirement of an actuarial value of at least 60 percent (we’ve referred to this as qualifying coverage) and is considered affordable. Under the ACA, employee-only coverage is considered affordable if it doesn’t cost the employee more than 9.5 percent of his or her household income.

But the IRS must adjust the affordability threshold periodically to reflect differences in the increase in health insurance premiums relative to increases in income. For plan years beginning in 2015, this adjustment causes the affordability threshold to rise to 9.56 percent. In other words, employee-only coverage will be considered affordable as long as the employee is not asked to pay more than 9.56 percent of household income for it.

Please reach out with any questions. You can reach me at RRuotolo@Lockton.com or at my direct line: (646) 572-3962.

Dr. Ann Kulze is a physician, best-selling author and motivational speaker committed to sharing the joys of living well with as many people as possible. We’re excited to announce that right now, due to a new exclusive partnership arrangement with Lockton, employers like you can utilize the renowned wellness educator’s specific, easy-to-follow advice to help employees learn to live healthier.

Here are four good reasons to use Dr. Ann’s materials to strategically bolster your organization’s wellness efforts with employees:

Workplace Wellness Expertise

Simply put, Dr. Ann lives at the intersection of personal health and workplace wellness, and the new partnership allows Lockton to offer a variety of her materials to employee benefits clients to bolster their employee wellness efforts. The materials offer straightforward advice and special emphasis on helping employees to get on the road to personal health.

“I’m so excited to work with Lockton because I know they really understand that workplace wellness works in every sense of the word,” says Dr. Ann.

“I view our partnership as a powerful opportunity to leverage our respective core strengths to move the needle on behavioral change. Together we will work to improve the health of many of people and help improve the bottom line for businesses.”

Nutritional Expertise

According to Dr. Ann: “I don’t know of any other strategy available in all of modern day health that can deliver the depth and breadth of dazzling health benefits that nutritional excellence can provide.”

She should know—Dr. Ann received her undergraduate degree in food science and human nutrition from Clemson University and her medical degree from the Medical University of South Carolina, where she graduated valedictorian of her class.

Dr. Ann’s Grocery Lists (license the full library for one year) are popular with employees, as are the Live Life Guides and Eat Right for Life Webinar Series.

Healthy Lifestyles Expertise

Dr. Ann places particular emphasis on healthy lifestyle education. Her Weekly Wellness Tips are particularly popular with employees, and she also has had great success with her Focused Topic Webinars, where you can license a webinar on a single timely topic for either three months or a year.

Disease Prevention Expertise

The Live Life Guides, the Weekly Wellness Tips and nutritional programs like Dr. Ann’s Grocery Lists are designed with disease prevention in mind, where the cultivation of healthy behavioral choices builds toward a healthy lifestyle.

J. Michael Brewer, President of Lockton Benefit Group, concludes: “We were looking for a high-profile physician to help us reinforce the basic tenets of our Lockton Health Risk Solutions®; program, which is all about helping organizations address employee health risks as a way to reign in rising healthcare costs. When I first met Dr. Ann, in addition to her obvious expertise, I was instantly impressed by her passion and energy for changing lives. She seemed like a natural fit.”

The final regulations provided implementation guidance on three interrelated PPACA provisions; namely, the employer play or pay mandate, the limit on health plan waiting periods, and the employer reporting obligations in connection with the employer mandate. (The reporting regulations also include employer and insurer reporting obligations in connection with the individual mandate.)

The final rules don’t stray too far from the proposed rules, and where they do stray, in many cases the changes are helpful to employers. But the final rules—particularly the play or pay rules—leave considerable ambiguity and challenges, according to the Lockton Benefit Group, who discuss the impact these regulations will have on employers in their recently published white paper.

In addition to helpful background and context on the latest PPACA regulations, Lockton Compliance experts weigh in on different aspects of the employer play or pay mandate, including obligations and penalties, transition rules, methods of determining full-time employees based on hours of service, and transition rules for employers with non-calendar year plans. Other topics covered in the white paper include ways of making the offer of coverage, special rules for educational institutions, the nexus between play or pay and the staffing firm, special rules governing expatriate employees, waiting periods, and the challenges of policing the mandates.

Many employers looking for unbiased advice have relied on Lockton, the world’s largest privately held insurance broker, to provide objective, unfiltered advice regarding their exchange options.

“We’re providing independent, objective advice and tools designed to help employers achieve their HR and employee benefits goals and decide if a private exchange strategy makes sense. We’ll help employers evaluate all available strategies and potential choices among the many vendors,” said Lockton’s Director of Exchange Solutions, Mike Smith.

Employer-Centric Tools
“If an exchange is a good fit, we can provide further assistance: from evaluation to contract negotiations to implementation to ongoing support. This is an employer-centric not product-centric approach. It doesn’t have to be a defined contribution strategy, but it does have to be the right fit for the employee, as well as the employer,” Smith adds.

“Some early entrants into the exchange market invested millions into group or individual benefits administration systems and services, so it’s not surprising they’re pushing their solutions. Others acquired these administration, decision-support and communication engines recently to enter or enhance their offerings. An exchange is a way to continue to capitalize on these large investments,” Smith explains.

“But nearly eight years ago Lockton reached a decision to create our HR Outsourcing and Technology Practice to better understand the services, performance and overall value of the players in the benefits administration market rather than provide these services. As such, we’ve been collecting data and providing implementation support for many years,” he says.

“These are unique capabilities we use to help clients examine whether to move forward with an exchange, and we’ve also developed financial modeling and vendor assessment tools to dive deeply into the advantages and disadvantages of exchange deployment for both employers and their valued employees,” says Smith.

“Most exchange discussions focus on potential cost savings to the employer. But we also review the advantages of broader consumer engagement and plan choices balanced against the potential for higher contributions or lower plan values, which impacts an employer’s ability to attract and retain talent,” he adds.

Unbiased Advice
Lockton offers packaged exchange solutions as part of its exchange strategy. However, because Lockton does not have an exclusive partnership with any exchange provider, they are able to offer unbiased, vendor-neutral advice.

“In providing objective advice about exchange solutions we’ve reaffirmed our position as a trusted advisor to employers. Multiple studies now indicate that employers are looking at private exchange options for both active and retired employees, however, 69 percent of employers also believe, according to the Private Exchange Evaluation Collaborative, that advisory services related to exchanges should be independent from the exchange owner. This is consistent with what Lockton’s clients are saying: Many consultants, carriers, and brokers offer products, but unbiased advice is still what’s valued most,” Smith explains.

Helping You Decide
According to J. Michael Brewer, President of Lockton Benefit Group: “Our clients count on us to deliver expert, unbiased advice about their employee benefits plans, and our position remains the same with private exchanges: Tell us your problem and we’ll help you solve it. Your business might be a good fit for a private exchange; it might not. If it is, which exchange might make the most sense? We’ve developed the tools and expertise to help you decide. This is a natural extension of the world class consulting we’ve been doing for a long time.”

Is your organization considering private exchanges? Please reach out for a cost-free consultation if I can be of further assistance at (646) 572-3962 or RRuotolo@Lockton.com.